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Presentation: Two step approach to Keratoconus
1. By
Dr Waleed Al-Tuwairqi, MD
Elite Medical & Surgical Center
Riyadh -KSA
7th International Congress
Of Corneal Cross-Linking
2011
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2. بسم ال الرحمن الرحيم
In the name of Allah, Most Gracious, Most Merciful
Saudi Desert Mecca
Riyadh Elite
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3. Selecting the right patient for ICR
Observing post-op results for 6-12 months
Enhancing post-ICR results with PRK+CXL
Reviewing the results of this approach
7th International Congress of Corneal Cross-Linking
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4. KC
Terminal
KC Advanced - CS
KC Moderate - ICS
KC Moderate - BSV
KC Early - GSV
KC Suspect - ESV
7th International Congress of Corneal Cross-Linking
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5. 1. BSCVA 20/20 or better
2. Corneal Coma < 0.5um
3. Post. Elevation < 15um
4. UNCVA for Near J1 or Better
5. Subjectively Patient easily can drive at night
6. Max K < 48 D
7th International Congress of Corneal Cross-Linking
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6. 1. BSCVA 20/25 or better
2. Corneal Coma < 1.5um
3. Post. Elevation < 40um
4. UNCVA for Near J2 or Better
5. Subjectively Patient can drive at night
6. Max K < 51 D
7th International Congress of Corneal Cross-Linking
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7. 1. BSCVA 20/40 or better
2. Corneal Coma 1.5-4.0um
3. Post. Elevation > 40um
4. UNCVA for Near J2 or Worse
5. Subjectively Night vision difficulty
6. Max K 48-55 D
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8. 1. BSCVA 20/50 or less
2. Corneal Coma > 4um
3. Post. Elevation > 60um
4. UNCVA for Near J3 or Less
5. Subjectively Symptomatic
6. Max K > 60 D
7. Cone Dimension 3*3 or 5*5
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9. G.S.V. B.S.V. I.C.S.
ICR (B.S.V. G.S.V.)
PRK+CXL
&
Or ?
PRK+CXL
ICL+CXL
(Irregular central cornea Regular central cornea)
7th International Congress of Corneal Cross-Linking
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34. Based on our review, ICR followed later by
PRK+CXL is an effective & safe approach in
making a functional change in the life style of
cases of moderate KC
We recommend to be done for the following
group of patients …..
7th International Congress of Corneal Cross-Linking
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35. 1. MAX K 55D or less
2. Sphere -6D
3. Coma 1.5-4.0 u
4. Post. Elevation >??
5. Pachymetry 450 u or more
6. Clarity Clear cornea
7. Gain of lines 2 lines or more
(expect to achieve in 2nd step)
7th International Congress of Corneal Cross-Linking
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